The purpose of a new study published in Climacteric was to assess sexual activity and menopausal symptoms in middle-aged Chinese women and to correlate these with their vaginal maturation status (VMS). In this study, 120 women between 45 and 60 years of age were assigned to four groups: premenopause (Pre-M), perimenopause (Peri-M), early postmenopause (Post-EM), and late postmenopause (Post-LM). The menopausal symptoms were assessed using the Menopause Rating Scale. VMS was determined using the vaginal maturation index (VMI) and the pH value. Sexual activity including sexual frequency and distress was measured using self-administered questionnaires. It was observed that a high proportion (48.2%) of Post-LM women reported low sexual frequency while a high proportion (24.2%) of Peri-M women reported sexual distress. Physical or mental exhaustion and sexual problems were the most prevalent symptoms, followed by sleeping problems and hot flushes or sweating, which were rated as severe or very severe. In fact, physical or mental exhaustion and sexual problems became more frequent as menopausal stages progressed. On the other hand, hot flushes or sweating was more prominent in women in the Peri-M and Post-EM groups. The Post-LM group exhibited lower VMI and higher pH values than the Pre-M and Peri-M groups and pH was positively correlated with sexual problems. The findings suggested that advancing menopausal status is associated with prevalent physical or mental exhaustion and sexual problems in middle-aged women. Hot flushes or sweating is among the most frequent menopausal symptoms rated as severe or very severe. Furthermore, urogenital symptoms are associated with pH in these women.